Inducing premature atrial contractions for the purpose of monitoring autonomic tone risk of sudden cardiac death and ischemic events

• US 8,548,589 B2
• Filed: 07/16/2009
• Issued: 10/01/2013
• Est. Priority Date: 07/13/2005
• Status: Active Grant

• Current Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Original Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Inventors: Farazi, Taraneh Ghaffari, Falkenberg, Eric
• Primary Examiner(s): Layno, Carl H
• Assistant Examiner(s): Sarcione, Jessica
• Application Number:
  US12/504,506
• Publication Number:
  US 20090281440A1
• Time in Patent Office: 1,538 Days
• Field of Search: 607/9, 607 17- 18, 607 25- 26, 600508-510, 600/519, 600/521
• US Class Current: 607/25
• CPC Class Codes: A61B 5/0031 Implanted circuitry
• CPC Class Codes: A61B 5/02405 Determining heart rate variability
• CPC Class Codes: A61B 5/36 Detecting PQ interval, PR interval or QT interval
• CPC Class Codes: A61B 5/364 Detecting abnormal ECG interval, e.g. extrasystoles, ectopic heartbeats
• CPC Class Codes: A61B 5/4035 Evaluating the autonomic nervous system
• CPC Class Codes: A61B 5/7275 Determining trends in physiological measurement data; Predicting development of a medical condition based on physiological measurements, e.g. determining a risk factor
• CPC Class Codes: A61N 1/36114 Cardiac control, e.g. by vagal stimulation stimulating the heart A61N1/362
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
• CPC Class Codes: A61N 1/365 controlled by a physiological parameter, e.g. heart potential evoked response A61N1/371
• CPC Class Codes: A61N 1/36585 controlled by two or more physical parameters
• CPC Class Codes: A61N 1/3702 Physiological parameters A61N1/365 takes precedence; evoked response A61N1/371
• CPC Class Codes: G16H 50/30 for calculating health indices; for individual health risk assessment

Abstract

Implantable systems, and methods for use therein, perform at least one of a cardiac assessment and an autonomic assessment. Premature atrial contractions (PACs) are induced to thereby cause corresponding premature contractions in the ventricles. Short-term fluctuations in cardiac intervals, that follow the premature contractions in the ventricles caused by the induced PACs, are monitored. At least one of a cardiac assessment and an autonomic assessment is performed based on the monitored fluctuations in cardiac intervals that follow the premature contractions in the ventricles caused by the induced PACs. This can include assessing a patient'"'"'s risk of sudden cardiac death (SCD), assessing a patient'"'"'s autonomic tone and/or detecting myocardial ischemic events based on the monitored fluctuations in cardiac intervals that follow the premature contractions in the ventricles caused by the induced PACs.

Claims

1. For use with an implantable system, a method of performing at least one of a cardiac assessment and an autonomic assessment, comprising:

(a) inducing premature atrial contractions (PACs) to thereby cause a corresponding premature contractions in the ventricles;

(b) monitoring morphology of a signal that is indicative of cardiac intervals that follow the premature contractions of the ventricles caused by the induced PACs;

(c) performing at least one of a cardiac assessment and an autonomic assessment, based on the monitored morphology of the signal that is indicative of cardiac intervals that follow the premature contractions of the ventricles caused by the induced PACs, wherein performing the assessment comprises identifying a period as a myocardial ischemic event based on the monitored morphology of the signal that is indicative of cardiac intervals that follow the premature contractions of the ventricles caused by the induced PACs; and

(d) triggering one or more responses based on the assessment.

2. The method of claim 1, wherein step (c) comprises assessing a patient'"'"'s risk of sudden cardiac death (SCD) based on the monitored morphology of the signal that is indicative of cardiac intervals that follow the premature contractions of the ventricles caused by the induced PACs.

3. The method of claim 1, wherein step (c) comprises assessing a patient'"'"'s autonomic tone based on the monitored morphology of the signal that is indicative of cardiac intervals that follow the premature contractions of the ventricles caused by the induced PACs.

4. The method of claim 1, wherein step (c) includes comparing the monitored morphology to a baseline morphology, and identifying a myocardial ischemic event when the monitored morphology differs from the baseline morphology by more than a specified degree.

5. The method of claim 1, wherein the triggered response comprises storing information related to the assessment for later retrieval or transmission.

6. The method of claim 1, wherein the triggered response comprises triggering therapy based on an outcome of the assessment.

7. The method of claim 1, wherein the triggered response comprises alerting at least one of a patient and a medical practitioner based on an outcome of the assessment.

8. An implantable system for performing at least one of a cardiac assessment and an autonomic assessment, comprising:

means for inducing premature atrial contractions (PACs) to thereby cause corresponding premature contractions in the ventricles;

means for monitoring morphology of a signal that is indicative of cardiac intervals that follow the premature contractions of the ventricles caused by the induced PACs; and

means for performing at least one of a cardiac assessment and an autonomic assessment, based on the monitored morphology of the signal that is indicative of cardiac intervals that follow the premature contractions of the ventricles caused by the induced PACs, wherein the means for performing identifies a myocardial ischemic event based on the monitored morphology of the signal that is indicative of cardiac intervals that follow the premature contractions of the ventricles caused by the induced PACs.

9. The system of claim 8, wherein the means for performing assesses a patient'"'"'s risk of sudden cardiac death (SCD) based on the monitored morphology of the signal that is indicative of cardiac intervals that follow the premature contractions of the ventricles caused by the induced PACs.

10. The system of claim 8 wherein the means for performing assesses a patient'"'"'s autonomic tone based on the monitored morphology of the signal that is indicative of cardiac intervals that follow the premature contractions of the ventricles caused by the induced PACs.

11. The system of claim 8 further comprising means for storing information indicative of a patient'"'"'s condition based on the assessment.

12. An implantable system for performing at least one of a cardiac assessment and an autonomic assessment, comprising:

a pulse generator programmed to induce premature atrial contractions (PACs) to thereby cause corresponding premature contractions in the ventricles;

a morphology detector programmed to monitor morphology of a signal that is indicative of cardiac intervals that follow the premature contractions of the ventricles caused by the induced PACs; and

a microprocessor programmed to perform at least one of a cardiac assessment and an autonomic assessment, based on the monitored morphology of the signal that is indicative of cardiac intervals that follow the premature contractions of the ventricles caused by the induced PACs, wherein the microprocessor is programmed to compare the monitored morphology to a baseline morphology, and identify a myocardial ischemic event when the monitored morphology differs from the baseline morphology by more than a first specified degree.

13. The implantable system of claim 12 wherein the microprocessor is further programmed to stimulate the vagus nerve when a myocardial ischemic event is identified.

14. The implantable system of claim 12 wherein the microprocessor is further programmed to compare a ST segment shift to a threshold, and wherein the microprocessor confirms the identity of a myocardial ischemic event when the ST segment shift threshold is crossed.

15. The implantable system of claim 12 wherein the microprocessor is further programmed to identify a risk of sudden cardiac death when the monitored morphology differs from the baseline morphology by more than a second specified degree, wherein the second specified degree is a smaller value than the first specified degree.

16. The implantable system of claim 12 wherein the microprocessor is further programmed to:

monitor an ischemic burden by determining a number of ischemic events that occur during a predetermined period of time; and

compare the ischemic burden to one or more ischemic burden thresholds.

17. The implantable system of claim 16 wherein the microprocessor is further programmed to trigger one or more responses when the one or more ischemic burden thresholds are crossed.

18. The implantable system of claim 17 wherein the microprocessor is further programmed to trigger a first response when a risk of sudden death is identified while the ischemic burden is below the one or more ischemic burden thresholds.

19. The implantable system of claim 17 wherein the microprocessor is further programmed to:

trigger a second response when a risk of sudden death is identified while the ischemic burden crosses the one or more ischemic burden thresholds; and

trigger a third response when a risk of sudden death is identified while the ischemic burden is above the one or more ischemic burden thresholds, wherein the first, second, and third responses are different.

20. The implantable system of claim 16 wherein the microprocessor is further programmed to:

identify a risk of sudden cardiac death when the monitored morphology differs from the baseline morphology by more than a second specified degree; and

monitor the risk of sudden cardiac death over the predetermined period of time.

21. The implantable system of claim 12 wherein the pulse generator is further programmed to deliver a ventricular pacing pulse a short AV delay after the PAC is induced.

22. For use with an implantable system, a method of performing at least one of a cardiac assessment and an autonomic assessment, comprising:

(a) inducing a premature atrial contraction (PAC) that is followed, after an AV delay, by delivery of a ventricular pacing pulse;

(b) monitoring short-term fluctuations in cardiac intervals that follow the delivery of the ventricular pacing pulse that followed the induced PAC;

(c) performing at least one of a cardiac assessment and an autonomic assessment, based on the monitored fluctuations in cardiac intervals that follow the delivery of the ventricular pacing pulse that followed the induced PAC, wherein performing the assessment comprises identifying a myocardial ischemic event based on the monitored morphology of the signal that is indicative of cardiac intervals that follow the premature contractions of the ventricles caused by the induced PACs; and

(d) triggering one or more responses based on the assessment.

23. The method of claim 22, wherein the triggered response comprises storing information related to the assessment for later retrieval or transmission.

24. The method of claim 22, wherein the triggered response comprises triggering therapy based on an outcome of the assessment.

25. The method of claim 22, wherein the triggered response comprises alerting at least one of a patient and a medical practitioner based on an outcome of the assessment.